Forms
You can download individual forms in PDF format:
Blue Cross Forms
- Application – Dental and Health
- Application – Dental and Health (French)
- Application – Health
- Application – Health (French)
- Application – For new hires when coverage not compulsory – Health/Dental
- Application – For new hires when coverage not compulsory – Health/Dental (French)
- Application – For new hires when coverage not compulsory – Health
- Application – For new hires when coverage not compulsory – Health (French)
- Application – Survivor Benefit for Actives
- Application – Retiree Health and Dental
- Application – Retiree Health and Dental (French)
- Application – Retired WANTE plan
- Blue Cross – Cancellation Request
- Blue Cross – Loss of Coverage Form
- Blue Cross – Notice of Change Form
- Blue Cross – Health/Vision Benefits Claim Form
- Blue Cross – Dental Claim Form
- Blue Cross – Glucose Monitoring – Special Authorization Request Form
- Blue Cross – Pre-Authorized Debit Application for Leave of Absence
- Blue Cross – Brochure for mybluecross
- Blue Cross – How to submit a claim in mybluecross
Canada Life (formerly Great-West Life) Forms
- MPS 103 – Change of Beneficiary and/or Appointment of Trustee
- MPS 301 – Application for Benefits
- MPS 400 – Request for Information when Employee Transfers from Another School Division
- School Division Contact List for form MPS 400
- MPS 401 – Request to Increase or Reduce Coverage – Evidence Not Required
- MPS 402 – Request to Increase Coverage – Evidence Required
- MPS 403 – Selection of Payment Method on Approved Leave
- MPS 404 – Overdue Premium Letter
- CL M62(PS) – Group Life Claim Form for Employer
- CL M62(PS) – Group Life Claim Form for Employer (French)
- CL M62(CS) – Group Life Claim Form for Claimant
- CL M62(CS) – Group Life Claim Form for Claimant (French)
- CL M63 – Attending Physician’s Certificate of Death
- CL M4437 – Accidental Dismemberment or Specific Loss Claim Form
- CL M4442 – Certificate of Attending Physician Dismemberment or Loss
- CL M6710 – Accidental Death Dismemberment & Specific Loss Claim Form
- CL M642 – Employer Statement – Life Waiver of Premium
- CL M642 – Employer Statement – Life Waiver of Premium (French)
- CL M4811 – Employee Statement – Life Waiver of Premium
- CL M4811 – Employee Statement – Life Waiver of Premium (French)
- CL M4811 – Employee Statement Guide – Life Waiver of Premium
- CL M4307 – Attending Physician’s Statement – Life Waiver of Premium
- CL M5995 – Evidence of Insurability Form
- CL M5725 – Conversion Notification
- CL – Conversion Facts
- CL – Conversion Facts (French)
- CL M7450 – Over Age Dependent
- CL M7354 – Advance Payment Request Form
- Should I Convert My Group Life Insurance?
- Devrais-je transformer mon assurance-vie collective?
- Life Claim Guide